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Differential diagnosis of wide QRS tachycardia (WQRST) on the electrocardiogram remains a challenging exercise. Correct diagnosis is important for prescribing appropriate therapy and determining prognosis. Differential diagnosis of wide QRS tachycardia revolves around differentiation between supraventricular tachycardia with aberrant conduction and ventricular tachycardia. Observations such as clinical history, findings of physical examination during tachycardia, AV dissociation, QRS morphology in lead V1 and lead V6, precordial concordance, RS complexes in precordial leads, contralateral bundle branch block during wide QRS tachycardia, R wave morphologies in lead aVR, and ventricular initial/terminal velocity of conduction ratio can help arrive at the correct diagnosis with reasonable accuracy. The observations described here can help arrive at the correct diagnosis of WQRST with both reasonable accuracy and confidence., The diagnosis of wide QRS tachycardia can be challenging, but is essential for appropriate therapy. The differentiation is often between supraventricular tachycardia with aberrant conduction and ventricular tachycardia. A review of historical, clinical, electrocardiographic information during wide QRS tachycardia while keeping in mind the pitfalls and exceptions, may help arrive at the correct diagnosis with reasonable accuracy and confidence

The majority of patients diagnosed with cancer are ≥65 years. However, inclusion of older patients with cancer in clinical trials is limited, and so there is less evidence to guide systemic therapeutic decisions in these patients. There is also debate surrounding the definition of “older patients”. Additionally, comorbidities, as well as life expectancy will influence compliance to any treatment, and physicians may favour less intense regimens for these patients or best supportive care alone. In patients with biliary tract cancer (BTC), surgery followed by adjuvant capecitabine (BILCAP phase 3 trial) is the only potentially curative option, but patients often present with advanced disease, and palliative systemic treatment is given. The availability of novel targeted therapies (oral and monotherapy) in selected populations of patients with BTC may increase the therapeutic artillery for these older patients. Trials to date in patients with BTC have not been age-specific and have not always included age subgroup analysis, and so the evidence to support treatment of older patients is derived via extrapolation, primarily, with only 35% being >60 years in the adjuvant BILCAP study, for example. When this evidence is provided, treated patients tend to gain equivalent survival benefit, irrespective of age. A comprehensive clinical geriatric assessment is recommended. Revision of existing BTC treatment guidelines should incorporate some reference to best practice in older patients with BTC. Observational data may also provide valuable insights in this population. Age sub-group analysis should be encouraged in prospective clinical trials including patients with BTC, with age-specific trials favoured.

IntroductionPancreatic exocrine insufficiency (PEI) in patients with pancreatic malignancy is well documented in the literature and is known to negatively impact on overall survival and quality of life. A lack of consensus opinion remains on the optimal diagnostic test that can be adapted for use in a clinical setting for this cohort of patients. This study aims to better understand the prevalence of PEI and the most suitable diagnostic techniques in patients with advanced pancreatic malignancy.Methods and analysisThis prospective observational study will be carried out in patients with pancreatic malignancy (including adenocarcinoma and neuroendocrine neoplasms). Consecutive patients with inoperable pancreatic malignancy referred for consideration of first-line chemotherapy will be considered for eligibility. The study comprises three cohorts: demographic cohort (primary objective to prospectively investigate the prevalence of PEI in patients with inoperable pancreatic malignancy); sample size 50, diagnostic cohort (primary objective to design and evaluate an optimal diagnostic panel to detect PEI in patients with inoperable pancreatic malignancy); sample size 25 and follow-up cohort (primary objective to prospectively evaluate the proposed PEI diagnostic panel in a cohort of patients with inoperable pancreatic malignancy); sample size 50. The following is a summary of the protocol and methodology.Ethics and disseminationFull ethical approval has been granted by the North West Greater Manchester East Research and Ethics Committee, reference: 17/NW/0597. This manuscript reflects the latest protocol V.8 approved 21 April 2020. Findings will be disseminated by presentation at national/international conferences, publication in peer-review journals and distribution via patient advocate groups.Trial registration number194255, NCT0361643.

This study was conducted to evaluate the toxic effects of an azo dye carmoisine widely used in foods and to investigate its relation to carcinogenicity. Carmoisine administered into mice orally in four different doses as control, low, medium, and high equivalent to 0, 4, 200, and 400 mg/kg bw, respectively, for 120 days. The key toxicological endpoint was observed including animal body weight, organ weights, hematology, biochemistry, and molecular biology assessment. The body weights of medium‐ and high‐dose carmoisine‐treated mice group were significantly decreased as compared to the control mice group. Platelet, white blood cell and monocyte counts of treated group were considerably higher, while Hb and red blood cell counts were drastically lower than the control group. The biochemical parameters such as serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total protein, globulin, urea, and creatinine level were significantly increased, while serum cholesterol level was decreased after treatment as compared to the control. RT‐PCR results showed that expression of Bcl‐x and PARP gene was intensively increased, whereas expression of p53 gene was decreased in the mouse liver tissues treated with carmoisine. This study revealed that high‐dose (400 mg/kg bw) treatment of carmoisine was attributable to renal failure and hepatotoxicity. It also would be suspected as a culprit for liver oncogenesis.

Breast cancer (BC) is considered the second leading cause of cancer-related death in women. Accurate diagnosis is thus of utmost importance to avoid the burden of BC. Ankyrin 2 (ANK2) encodes the structural membrane adapter protein ankyrin-B, which is ubiquitously expressed in the human body. In this study, bioinformatics tools were used to determine whether ANK2 could be used as a diagnostic and prognostic biomarker in BC. ANK2 expression was analyzed using ONCOMINE, UALCAN, GEPIA2, and GENT2. Data from these servers showed the downregulated expression of ANK2 in BC relative to that in normal tissue. Further, downregulated ANK2 expression was found in such conditions as estrogen receptor-negative, human epidermal growth factor receptor 2-positive, positive nodal status, basal-like tumor, and triple-negative breast cancer, according to the data from the bc-GenExMiner v4.5 server. Analysis of 18 BC studies retrieved from the cBioPortal database revealed 88 missense mutations with 0.46%–5.09% copy number alterations in the ANK2 gene sequence. Additionally, a positive correlation between downregulated ANK2 expression and reduced survival probability of BC patients was revealed by a Kaplan–Meier plotter. Moreover, chordin-like 1, a tumor suppressor, was highly co-expressed with ANK2, as shown by the ONCOMINE, UCSC Xena, and GEPIA2 tools. The signaling pathways and gene ontologies of ANK2 and its co-expressed genes were identified using the Enrichr platform. The present results suggest that the ANK2 may serve as a biomarker for diagnosis, prognosis, and therapeutic purposes in BC.

BACKGROUND Brain metastases (BMs) incidence in patients with extra-pulmonary neuroendocrine neoplasms (EP-NENs) is unclear, with no available management recommendations. This study aimed to review the clinical presentation, management and survival outcomes of patients with EP-NENs and BMs at a European Centre of Excellence. METHODS A retrospective single-centre analysis of consecutive patients with EP-NENs (Aug 2004-Feb 2020) was conducted. Median overall survival (OS)/survival from BMs diagnosis were estimated (Kaplan Meier). RESULTS Of 786 patients, 15 (1.9%) had BMs, median age 61y (range 15–77); 8 (53%) male, primary NEN site: unknown 40%; oesophageal 13%; small bowel 13%; pancreas 13%; gastric 7%; cervix 7% and bladder 7%. Most patients with BMs had grade 3 (G3) NENs (11, 73%), 3 (20%) were G2 and 1 (7%)G1. Eight (53%) had poorly-differentiated NENs, 6 well-differentiated and 1 not recorded. Two (13%) patients had synchronous BMs at diagnosis, whilst 13 (87%) developed BMs metachronously. Median time to development of BMs after initial NEN diagnosis: 15.9 months (range 2.5–139.5). Five patients had a solitary BM, 4 had 2–9 lesions and 6 had >10 BMs. The most commonly affected sites were the cerebrum (13, 87%), cerebellum (6, 40%), leptomeninges (2, 13%) and orbit (1, 7%). The most common presenting symptoms were limb weakness, headache, confusion, visual disturbance (each n=3, 20%), seizures (2, 13%), word-finding difficulty (2, 13%) and facial weakness/ptosis (1, 7%). Median OS from initial NEN diagnosis was 23.6-months [95%-CI 15.2–31.3]; median time to death from BMs diagnosis was 3.0-months [95%-CI 0.0–8.3]. Treatment of BMs was surgery (n=3); radiotherapy (n=6); 5 had WBRT, one localised radiotherapy (orbit). Six (40%) had best supportive care. CONCLUSION BMs in patients with EP-NENs are rare and predominantly in G3 NENs, with diverse intracranial distribution. Although uncommon, BMs from NENs behave aggressively and greater understanding is needed to improve therapeutic outcomes.

Background: Molecular profiling is becoming increasingly relevant in the management of patients with advanced cancer, to identify targetable aberrations and prognostic markers to enable a precision medicine strategy. Methods: Eligible patients were those diagnosed with advanced biliary tract cancer (BTC) including intrahepatic (iCCA) and extrahepatic cholangiocarcinoma (eCCA), gallbladder cancer (GBC), and ampullary carcinoma (Amp) who underwent molecular profiling between April 2017 and June 2020 based on analysis of either tumour samples (FoundationOne CDx&reg, /Oncomine&reg, platforms) or ctDNA (FoundationOne Liquid&reg, platform (Foundation Medicine, Cambridge, MA, USA)). Baseline patient characteristics and molecular profiling outcomes were extracted. The primary aim was to describe sample failure rate. Secondary aims included description of reason for sample failure, summary of findings derived from molecular profiling, and assessment of concordance between paired tissue and ctDNA samples. Results: A total of 149 samples from 104 individual patients diagnosed with advanced BTC were identified and eligible for this analysis: 68.2% iCCA, 100% advanced stage, 94.2% received palliative therapy. The rate of sample failure was 26.8% for tissue and 15.4% for ctDNA, p-value 0.220, predominantly due to insufficient (defined as &lt, 20%) tumour content in the sample (the reason for 91.2% of tissue sample failure). Of the 112 samples successfully analysed, pathological molecular findings were identified in the majority of samples (88.4%) and identification of pathological findings using ctDNA, was possible regardless of whether the patient was on active treatment at time of blood acquisition or not (p-value 1.0). The rate of targetable alterations identified was 40.2% across all successfully-analysed samples (39 iCCA, 6 non-iCCA): IDH1 mutations (19.1% of individual patients), FGFR2 alterations (10.1% and 5.6% of individual patients had FGFR2 fusions and mutations, respectively), 10.6% of all patients (12.4% of patients with successfully analysed samples) entered trials with matched targeted therapies as a consequence. Concordance of findings for paired tissue and paired tissue-ctDNA was high (3/3, 100% and 6/6, 100%, respectively). Twelve ctDNA samples were taken prior to palliative treatment initiation, median maximum mutant allele frequency (MAF) was 0.47 (range 0.21&ndash, 19.8), no significant association between reported maximum MAF and progression-free survival (PFS) or overall survival (OS) (all Cox regression p-values &gt, 0.273). A total of 15 patients (16.6%) harboured alterations in DNA damage repair (DDR) genes, when treated with platinum-based chemotherapy, there was a trend towards increased partial response rate (21.4% vs. 15.9%, p-value 0.653), radiological benefit rate (64.3% vs. 36.2%, p-value 0.071), and longer OS (median OS 20.4 months (95% CI 7.9&ndash, 26.7) vs. 13.3 (95 CI 11.0&ndash, 16.4), Cox Regression HR 0.79 (95% CI 0.39&ndash, 1.61), p-value 0.527). Conclusions: Molecular profiling is of use for identification of novel therapeutic strategies for patients with advanced BTC (mainly iCCA). One in four archived tissue samples may have insufficient tumour content for molecular profiling, ctDNA-based approaches may overcome these obstacles.

Resistance to gemcitabine chemotherapy is common in patients with pancreatic ductal adenocarcinoma (PDAC), biliary tract cancer (BTC) and ovarian cancers (OC), conferring poor survival. Use of ProTide technology led to the development of a ‘partially-activated’ monophosphorylated gemcitabine compound, termed NUC-1031. NUC-1031 enters cancer cells independent of the human equilibrative nucleoside transporter, does not require deoxycytidine kinase-mediated activation and resists cytidine deaminase-mediated breakdown into toxic by-products. The phase I PRO-001 trial recruited 68 patients with advanced solid tumours; of the 49 patients that had response-evaluable disease, 5 (10%) had a partial response (PR) and 33 (67%) had stable disease (SD). Subsequently, the PRO-002 study assessed the safety and efficacy of NUC-1031 combined with carboplatin for patients with OC (n = 25); preliminary data from this study reported one (4%) unconfirmed complete response (CR), 8 (35%) PRs and 13 (57%) patients with SD, the final outcome data are awaited. The ABC-08 trial for advanced BTC assessed safety and efficacy of NUC-1031 combined with cisplatin; 14 patients were recruited with a 50% objective response rate in the intention to treat population at interim analysis. ACELARATE, the phase III trial in first-line advanced PDAC comparing NUC-1031 to gemcitabine monotherapy, recruited 200 patients but has been paused for futility analysis. Early studies demonstrate NUC-1031 is well tolerated with favourable pharmacokinetic profiles. NUC-1031 use in PDAC remains unclear, but encouraging results of disease control in BTC and OC has prompted phase II and III trial development. NuTide 121, is a phase III trial comparing cisplatin-NUC 1031 combination to the standard of care cisplatin-gemcitabine and recruitment is ongoing. Recruiting trials and mature data from existing studies will help inform on the impact of NUC-1031 on patient survival over standard gemcitabine.

Advanced hepatocellular cancer (HCC) is the fourth leading cause of cancer-related death globally and is most common in elderly patients with a peak incidence in the UK at ages 85-89 years. In addition to the well-established risk factors of alcohol and viral hepatitis B and C, rising obesity and associated non-alcoholic fatty liver disease is projected to contribute to increased incidence of advanced HCC in elderly patients. The management of advanced HCC is changing rapidly; for over a decade the multi-kinase inhibitor sorafenib has been the only treatment option that offered a proven survival advantage, but in the last 4 years other treatment options have emerged including other kinase inhibitors, and monoclonal antibodies targeting angiogenesis and immune checkpoint inhibitors. Recent clinical trials have recruited older patients with no maximum age exclusion criteria, and age has not been found to be predictive for treatment effect in subgroup analyses. Chronological age is an unreliable measure of fitness for treatment and frailty may be a more apt descriptor, but the lack of a unified assessment tool has limited its use in current practice. Development of unified frailty assessments and prospective large-scale studies of novel systemic therapies where age and frailty are evaluated would be informative.

Repeated implantation failure (RIF) implies at least 3 consecutive treatment cycles of failed in vitro fertilization-embryo transfer (IVF-ET), in which 1 or 2 quality embryos...

Paracetamol (PCT) is a mostly used analgesic and antipyretic drug [1]. Overdoses can cause of liver and kidney damage [2]. The primary metabolism of PCT occurred in the liver...

Paracetamol or acetaminophen is a medication commonly used in pain and fever. It is typically used for mild to moderate pain relief. It can produce selective inhibition to the prostaglandin synthesis. We envisage the density functional theory (DFT) with B3LYP/6-31G+(d,p) basis set to optimize the newly modified derivatives. Thermodynamic properties, molecular orbital features, dipole moment, atomic partial charge and electrostatic potential have been calculated in order to compare their physicochemical and biological properties. Molecular docking, nonbonding interactions, and dynamics simulation have been performed against prostaglandin H2 (PGH2) synthase protein 5F19 to investigate their binding affinity, binding modes, and stability of the protein-drug complex. ADMET prediction has been utilized to compare the absorption, metabolism, and carcinogenic properties of new derivatives with parent drug (PCT). From physicochemical data, all modified structures are thermodynamically stable; most of them are chemically more reactive and show better binding affinity than the parent drug. ADMET calculations predict the improved pharmacokinetic properties of modified derivatives. Based on physicochemical, docking, dynamics simulation and ADMET prediction results, this study can be helpful to design a new analgesic and antipyretic drug.

Background: Occupational exposure is a significant factor for having respiratory symptoms and impairment of lung function in the working population. Construction workers impose a great risk of respiratory diseases since they continuously expose to construction hazards at their working place. The objective of this study was to explore the status of respiratory health of construction workers as well as correlation of blood parameters with it.Methods: This cross-sectional study was conducted among construction workers along with the control group (university staffs) by randomly selecting 50 individuals in each group from September 2019 to February 2020 in Tangail, Bangladesh. Questionaries’ survey was executed followed by spirometry and oximetry. After confirming abnormalities of lung function, blood was drawn for further IgE, ESR, and CRP analysis.Results: Significantly (p

Previous literature has sought prognostic factors for the survival of anal cancer patients. The present study aimed to determine prognostic factors for local disease recurrence, distant metastasis and survival for patients treated with radical chemoradiotherapy (CRT) at the Rosemere Cancer Centre, Preston, UK.Patients treated with CRT for nonmetastatic squamous cell anal cancer between September 2000 and January 2013 were studied. Kaplan-Meier and Cox regression analysis assessed the prognostic value of age, sex, tumour size, the proportion of the anal canal circumference involved (ACCI), nodal disease, tumour location and pretreatment haemoglobin.One hundred and 48 patients with a mean age of 63 years were studied, of whom 15% suffered local disease recurrence and 10% developed distant metastasis. The 5-year overall and cancer-specific survival rates were 84% and 86%, respectively. Predictors of local recurrence were tumour size5 cm and over two-thirds ACCI (P 0.01). Predictors of distant metastasis and poor survival were tumour size5 cm (P 0.01), node positive disease on imaging (P 0.05), over two-thirds ACCI (P 0.01) and a pretreatment haemoglobin level below 130 g/l (P 0.05). Multivariate analysis found large tumour size to be the most significant factor for local recurrence (P = 0.002) and survival (P = 0.02) whilst over two-thirds ACCI was most predictive of distant metastasis (P 0.001). Age, gender, palpable lymph nodes and tumour location were not of prognostic value for local disease recurrence, distant metastasis or survival.Tumour size, nodal disease, over two-thirds ACCI and low pretreatment haemoglobin confer poorer prognostic and survival outcomes. Use of intensity-modulated radiation therapy may allow greater radiation doses to be given for locally advanced tumours, thus improving local control and survival and reducing morbidity.

Background: A diagnosis of an old Inferior Wall Myocardial Infarction (IMI), on a routinely performed Electrocardiogram (ECG) often leads to further consultations and imaging studies. The aim of this study was to assess the predictive value of Q waves in inferior leads, alone or in combination with repolarization abnormalities, for the diagnosis of inferior wall myocardial infarction confirmed by imaging studies. Methods: Fifty-six patients, in whom computerized interpretation of the electrocardiogram resulted in the diagnosis of inferior wall myocardial infarction, and in whom imaging studies were also available, were included in this study. Electrocardiograms were performed using the GE MACHD 5500. Electrocardiograms were interpreted using the MUSE GE system. Echocardiograms and nuclear medicine cardiac imaging were performed and interpreted using standard equipment and techniques. S AS 9.3 software (SAS Institute, Inc., Cary, North Carolina) was used to calculate 95% exact binomial confidence intervals (CI) for the population PPVs. Results: Computerized interpretation of the ECGs leading to the diagnosis of old inferior wall myocardial infarction when compared with inferior wall myocardial infarction confirmed by imaging studies, had a positive predictive value of 52.78%. Adding the criteria of Q waves wider than 0.04 ms, using manual interpretation of ECG, increased the positive predictive value of the test to 80%. However, the presence of ST changes and/or negative or isoelectric T waves, in the presence of diagnostic Q waves in the inferior leads, increased the positive predictive value to 92%. Conclusion: These results suggest that the computerized interpretation of ECG results in a high rate of false positive readings of old inferior myocardial infarction. This may result in overutilization of imaging modalities. Presence of diagnostic Q waves in inferior leads, if accompanied by repolarization abnormalities, improves the accuracy of the electrocardiogram for the diagnosis of inferior wall myocardial infarction..

A three-condition (rejection, criticism, control) experiment (N=78) with gender treated as an additional factor and moderating variable examined gender differences in response to two types of threats to positive face - rejection and criticism - on a social-networking site. Results showed it did not matter if men or women were rejected or criticized on a social-networking site; both threats to positive face lead to more retaliatory aggression, compared to the control. However, men retaliated to a greater extent than women to both types of threats. Also, men responded differently to criticism than to rejection, while women's results did not vary. Findings are discussed in relation to face theory and politeness theory, particularly in regard to computer-mediated communication.

Za izdvajanje bioaktivnih peptida iz kompas meduze (Chrysaora sp.) izoliran je kolagen, te je hidroliziran s pomoću tri proteaze: tripsina, alkalaze i komercijalnog prozivoda Protamex. Izmjeren je i uspoređen učinak različito inhibiranih peptida na inhibiciju angiotenzin konvertirajućeg enzima (ACE), te je pomoću metoda FRAP i DPPH ispitana njihova antioksidativna aktivnost. Osim toga, ispitan je utjecaj trajanja hidrolize na bioaktivnost peptida, tj. na inhibiciju ACE i antioksidativnu aktivnost. Najveća je ukupna antioksidacijska aktivnost (FRAP) izmjerena u hidrolizatima dobivenim pomoću komercijalne proteaze Protamex (25-27 mM) nakon 7 sati hidrolize, te nakon 9 sati hidrolize pomoću tripsina (24-26 mM). Nasuprot tome, hidrolizati dobiveni pomoću tripsina imali su najveću sposobnost uklanjanja DPPH radikala (94 % nakon 1 sata i 92 % nakon 3 sata). Hidrolizati dobiveni pomoću tripsina imali su najbolju sposobnost inhibicije ACE (89 % nakon 3 sata). Pomoću dvojne masene spektrometrije određene su sekvencije peptida koje su imale najveću aktivnost, a rezultati pokazuju da su hidrolizati imali veći udjel hidrofobnih aminokiselina i jedinstvenih sekvencija aminokiselina, što vjerojatno pridonosi njihovoj biološkoj aktivnosti., Collagen isolated from the ribbon jellyfish (Chrysaora sp.) was hydrolysed using three different proteases (i.e. trypsin, alcalase and Protamex) to obtain bioactive peptides. Angiotensin-I-converting enzyme (ACE) inhibitory activity and antioxidant activities (i.e. ferric reducing antioxidant power (FRAP) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity) of the peptides were measured and compared, and the effect of the duration of hydrolysis on the bioactivity (ACE inhibitory and antioxidant activities) of peptides was also evaluated. FRAP activity was the highest in Protamex-induced (25–27mM) and trypsin-induced hydrolysates (24–26 mM) at 7 and 9 h, respectively. Conversely, hydrolysates produced by trypsin for 1 and 3 h showed the highest DPPH radical scavenging activities (94 and 92 %, respectively). Trypsin-induced hydrolysates (at 3 h) also showed the highest ACE inhibitory activity (89 %). The peptide sequences with the highest activities were identified using tandem mass spectrometry, and the results show that the hydrolysates had a high content of hydrophobic amino acids as well as unique amino acid sequences, which likely contribute to their biological activities.

BACKGROUND Atrial fibrillation is a relatively common arrhythmia often seen in patients with permanent pacemakers. In this study we aimed to assess the incidence of atrial fibrillation in patients whose pacemakers were programmed to pace in the right ventricle (VVI) and compared it with patients whose pacemakers were programmed in non-VVI mode(i.e. AAI or DDD). MATERIAL AND METHODS Records of the patients with permanent pacemaker or implantable-cardioverter-defibrillator were evaluated and analyzed. These patients had regular periodic follow-up evaluation over the last 10 years. (January 1, 2002 to December 31, 2012). Patient demographic, pacemaker data, pacing mode, review and analysis of arrhythmia log for occurrence of new atrial fibrillation and echocardiographic findings for left atrial size, mitral regurgitation, were analyzed and recorded. Left atrial size was classified as mild, moderate or severe enlargement, depending on the left atrial dimension. RESULTS Average age was 68 years. There was no gender predominance (51% male). Mean follow-up duration was 6 years and 3 months. Hispanic population represented the majority of the patients (65.4%). Majority of the devices (80.0%) were programmed as DDD pacing mode. Fifty-five patients (52.8%) did not develop atrial fibrillation. 85.7% of the patients paced in VVI-mode had atrial fibrillation while atrial fibrillation occurred in 37.4% among patients paced in non-VVI-mode. This difference was statistically significant (P

BACKGROUND: Sea cucumber (Stichopus vastus) is considered an underutilized resource, since only its stomach and intestines areeatenrawassaladinafewcountriesandtheremainingparts,especiallytheintegumentrichincollagen,isdiscarded.Hence a valuable by-product having potential nutraceutical and pharmaceutical applications is wasted. In the present investigation, pepsin-solubilized collagen (PSC) from the integument of S.vastus was isolated, purified and characterized. RESULTS: Sodium dodecyl sulfate‐polyacrylamide gel electrophoretic analysis showed that the purified collagen was of type I, consisting of three α1 chains of approximately 122 kDa each. The peptide map of PSC digested by V8 protease was different from that of calf skin type I collagen. Fourier transform infrared spectroscopy revealed that the triple helical structure was well preserved in isolated collagen. The denaturation temperature of PSC was 21.23 ◦ C and showed good gel-forming capability at pH 6.5 and 300 mmol L −1 NaCl. CONCLUSION: It is inferred that the collagen isolated from S. vastus integument has potential for use as an alternative to land-based mammalian collagen in food, nutraceuticals and pharmaceutical industries. c � 2012 Society of Chemical Industry

In light of the potential need for disinfection and nutrient removal at the Metropolitan Water Reclamation District of Greater Chicago's water reclamation plants (WRPs), the inhibitory effects of ferric chloride (FeCl3) on ultraviolet (UV) radiation disinfection was examined. Results of a 2007 preliminary study indicated that a 2-log reduction in fecal coliform (FC) concentrations for each WRP secondary effluent was achieved with a UV dose of 10 mJ/cm2 except for the John E. Egan (Egan) WRP, where FeCl3 addition in the aeration basin for phosphorus removal was being employed. A subsequent study examined the effect of Egan unfiltered (secondary) and filtered (final) effluent on UV disinfection in 2008 during FeCl3 application and 2009 upon cessation of FeCl3 application: FeCl3 addition and filtration had little effect on UV transmittance (UVT). However, with FeCl3 addition, secondary and final effluent had higher total iron and lower total phosphorus relative to the respective secondary and final effluent without FeCl3 addition. Final effluent with and without FeCl3 addition showed lower total suspended solids concentrations relative to secondary effluent. Collimated beam test results indicated that a higher UV dose was needed to achieve the desired log reductions with FeCl3 addition and secondary effluent. Therefore, filtration of the effluent may be required if FeCl3 addition for nutrient removal is used at WRPs that employ UV disinfection.Environmental Practice 12:275–284 (2010)

The Metropolitan Water Reclamation District of Greater Chicago (District) initiated a research study to determine the total numbers and percentages of antibiotic resistant fecal coliform (FC) bacteria in raw sewage (RS) entering and final effluents (FE) discharged from its seven Water Reclamation Plants (WRPs). The density of FC was determined on m-FC agar containing ampicillin (ampR-16 μg/ml), gentamycin (genR-8 μg/ml), tetracycline (tetR-8 μg/ml), or all three antibiotics. The study was primarily undertaken to determine whether secondary sewage treatment at the District WRPs adequately reduces the numbers and percentages of FCampR, FCtetR, FCgenR, FCamp/tet/genR in the FE. The numbers of ampR, tetR, genR, and amp/tet/genR FC observed in RS ranged from 2.0 × 105 to 1.1 × 107, 9.5 × 104 to 2.2 × 106, 95 to 1.5 × 104 and 90 to 9.5 × 103 per 100 mL, respectively. Secondary sewage treatment without disinfection was shown to reduce the number of antibiotic resistant FC by two-three orders of magnitude. The numbers of FCampR, FCtetR, FCgenR, and FCamp/tet/genR observed in non-disinfected FE ranged from 2.0 × 102 to 6.4 × 103, 2.2 × 102 to 4.1 × 103, 9 to FCtetR > FCgenR > FCamp/tet/genR. Only one FCamp/tet/genR bacteria was found in this study indicating that multiple-antibiotic resistant FC was virtually eliminated by secondary sewage treatment. The results of multivariate regression analysis showed that the percentages of antibiotic resistant FC in the FE from all seven District WRPs were lower than the percentages of these organisms in RS (p

Patient: Female, 70 Final Diagnosis: SA block induced by pyridostigmine Symptoms: Asymptomatic Medication: Pyridostigmine Clinical Procedure: Pacemaker insertion Specialty: Electrophysiology Objective: Unusual clinical course Background: Myasthenia gravis requires a long-term treatment with a parasympathomimetic agent, which may result in bradycardia and asystole. Pharmacologic treatment with a reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH) and Methylprednisolone is seen to improve the muscular symptoms but may reinforce potential bradyarrhythmias. This potential side effect can be treated with the levo isomer of atropine, Hyoscyamine, or Glycopyrollate in an intact conduction system. Case Report: A 70-year old Caucasian female patient with a family history of myasthenia gravis presented with mild weakness of the bilateral facial muscles, moderate dysarthria, dysphagia, diplopia predominantly on the right side and difficulty tracking ocular movements bilaterally. The treatment with pharmacological agents was initiated. Subsequently she developed asymptomatic bradycardia and SA-block. An improvement on Hyoscyamine failed to appear. A dual chamber pacemaker was placed. Conclusions: In symptomatic or asymptomatic bradycardia with significant high grade SA-block in patients with myasthenia gravis the insertion of a permanent pacemaker can be the definitive solution.

The molecular mass distribution, amino acid composition and radical-scavenging activity of collagen hydrolysates prepared from collagen isolated from the sea cucumber Stichopus vastus were investigated. β and α1 chains of the collagen were successfully hydrolysed by trypsin. The molecular mass distribution of the hydrolysates ranged from 5 to 25 kDa, and they were rich in glycine, alanine, glutamate, proline and hydroxyproline residues. The hydrolysates exhibited excellent radical-scavenging activity. These results indicate that collagen hydrolysates from S. vastus can be used as a functional ingredient in food and nutraceutical products.

Phosphorus removal using ferric chloride (FeCl 3 ) addition was demonstrated at the Egan Water Reclamation Plant. Concurrently, sludge thickening performance problems occurred in the gravity belt thickeners (GBTs). Blinding problems and polymer demand change were attributed to FeCl 3 and long sludge holding times. Laboratory tests were conducted to gain insight to the GBT problems. Sludge holding time effects before polymer conditioning and thickening and prolonged contact of the solids with FeCl 3 were evaluated via modified time-to-filter and blinding tests developed for this study. The tests assessed the sludge filterability under polymer and FeCl 3 conditioning treatments and varying sludge holding and FeCl 3 contact times. It was determined that fresh sludge was the easiest to thicken compared with sludge stored for any length of time. The FeCl 3 improved thickening; however, when both the FeCl 3 and polymer were used as conditioners, higher FeCl 3 concentrations resulted in thickening inhibition compared with polymer alone.

Essential cardiac electrophysiology : , Essential cardiac electrophysiology : , کتابخانه دیجیتال جندی شاپور اهواز

Aim: Recent literature has sought prognostic factors for survival outcomes in anal cancer patients. Similarly, our study aims to determine prognostic factors for local disease recurrence, distant metastases and survival from patients treated with standardized radical chemo-radiotherapy at the Rosemere Cancer Centre, Lancashire, UK. Methods: Patients treated with radical concurrent chemoradiation for non-metastatic squamous cell anal cancer from September 2000 to January 2013 were retrospectively studied. Kaplan-Meier and Cox Regression proportional hazards methods were used to assess prognostic value of age, sex, tumour size, anal canal circumference involved (ACCI), nodal disease, tumour location and pre-treatment haemoglobin. Results: A total of 148 patients (95 females, 53 males) with a mean age of 63 were studied. From the sample population 15% of patients suffered local disease recurrence and 10% developed distant metastases. The estimated five-year overall survival and cancer specific survival was 84% and 86% respectively. Predictors of local recurrence were tumour size greater than 5cm and over two-thirds ACCI (p Conclusions: Tumour size, nodal disease, over two thirds ACCI and low pre-treatment haemoglobin confer poorer prognostic and survival outcomes. Future use of intensity modulated radiation therapy (IMRT) can decrease patient morbidity, which may allow increase of radiation doses for locally advanced anal cancers and thus improve local control and survival outcomes. Disclosure: All authors have declared no conflicts of interest.

e15000 Background: Tumour size, nodal involvement and sex are recognized prognostic factors in squamous cell anal cancer. Our study aims to evaluate survival and potential prognostic factors amongs...

Ventricular rhythms originate from sites distal to the penetrating bundle of His. In the majority of cases, the resulting QRS complexes are abnormally wide, exhibit axis deviation, and have a range of bizarre morphologies. In some cases, however, ventricular ectopic impulses arise in the distal conduction structures themselves and therefore exhibit narrow QRS complexes. Three basic mechanisms are thought to account for the majority of ventricular rhythms: enhanced automaticity, reentry, and early and late afterdepolarizations. In the case of enhanced automaticity, single or multiple excitable foci spontaneously discharge impulses. In the case of reentry, the sinus impulse traverses a circuit within the distal conduction system or ventricular myocardium, forming a single ectopic ventricular beat if conduction through the circuit is an isolated event, or producing ventricular tachycardia if conduction through the circuit is repetitive. A reentry circuit may consist of anatomically separate pathways with differing conduction properties, or disparate conduction properties (anisotropy) in contiguous myocardium may provide a functional basis for reentry. If the circuit is very small, the mechanism is called micro-reentry. If the circuit consists of larger structures, such as a bundle branch and the contiguous myocardium, the resulting mechanism is called macro-reentry. (The reentry mechanism is described in detail in Chapters 11 and 13.) Early after-depolarization, an early depolarization that occurs before repolarization is complete, is now widely believed to be the physiologic substrate of polymorphic ventricular tachycardia.

In early fetal life, the atrial and ventricular myocardia are continuous. After approximately the first month of gestation, the formation of the annulus fibrosus begins the anatomical and electrical separation of the atria and ventricles, leaving the atrioventricular node and bundle of His as the only electrical connection between the upper and lower chambers. In approximately 0.3% of the population (3 of every 1000 individuals), however, this process of electrical isolation is incomplete. In these subjects, unobliterated myocardial strands persist, making one, or at times more, direct electrical connections between the atrial and ventricular myocardium. These congenitally anomalous fibers are known as accessory pathways or bypass tracts.

The commonly used term sick sinus syndrome refers to a constellation of disorders of sinus rhythm that includes (1) inappropriate sinus bradycardia, (2) barious forms of sinoatrial block, (3) sinus arrest, (4) tachycardia-bradycardia syndrome, (5) sinoatrial nodal suppression by ectopic beats, and (6) sinoatrial reentry. This group of arrhythmias is very often associated with other manifestations of conduction system disease, such as aytrioventricular, fascicular, and bundle branch block, and suppression of escape rhythms from subsidiary pacemakers.

The supraventricular tachycardias can be divided into those arrhythmias originating within the atria per se and those in which the atrioventricular node or accessory atrioventricular connections play a role. The latter arrhythmias are discussed in Chapter 13. Four important tachyarrhythmias, namely, atrial fibrillation, atrial flutter, atrial tachycardia, and multifocal atrial tachycardia, are considered in this chapter, as are premature atrial complexes and ectopic atrial rhythm.